Transcatheter aortic valve-in-valve implantation for residual prosthetic valve dysfunction and paravalvular leak after healed Enterococcus faecalis prosthetic valve endocarditis: a case report

Figures

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  Clinical course of a high-risk patient with controlled Enterococcus faecalis prosthetic valve endocarditis complicated by severe residual prosthetic valve dysfunction and paravalvular leak. The figure summarizes the diagnostic process, multidisciplinary Heart Team decision-making, valve-in-valve transcatheter aortic valve implantation strategy, and clinical outcome during follow-up.

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  Figure 1. Baseline transthoracic echocardiography demonstrating severe prosthetic valve dysfunction. (A) Continuous-wave Doppler assessment demonstrating severe prosthetic valve stenosis with elevated transvalvular gradients. (B) Colour Doppler imaging demonstrating severe central transprosthetic regurgitation. (C) Colour Doppler imaging demonstrating severe paravalvular leak.

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  Figure 2. Multimodality imaging assessment of the paravalvular leak. (A–E) Cardiac-gated computed tomography reconstructions demonstrating the aortic root anatomy, relevant anatomical measurements, and the location and extent of the paravalvular leak originating from the non-coronary sinus of Valsalva. (F) Patient-specific three-dimensional model illustrating the spatial relationship between the prosthetic valve and the paravalvular defect and supporting procedural planning.

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  Figure 3. Periprocedural imaging before and after valve-in-valve transcatheter aortic valve implantation. (A) Transoesophageal echocardiography before intervention demonstrating severe prosthetic valve dysfunction with severe regurgitation. (B) Aortic root angiography before implantation. (C) Post-implantation transoesophageal echocardiography demonstrating improved prosthetic valve haemodynamics with only mild residual paravalvular regurgitation. (D) Aortic root angiography after implantation confirming a reduction in regurgitation.

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  Figure 4. Follow-up transthoracic echocardiography at 12 weeks after valve-in-valve transcatheter aortic valve implantation. Doppler assessment (left) demonstrates improved transvalvular gradients, and two-dimensional colour Doppler echocardiography (right) demonstrates stable transcatheter valve position and trace residual paravalvular regurgitation.